Arthritis

What Is Arthritis?

In this discussion, we are talking about Osteoarthritis (OA), otherwise known as Degenerative Joint Disease (DJD).  It is completely different from septic arthritis (caused by infection), or immune-mediated arthritis (caused by a malfunction of the immune system, similar to rheumatoid arthritis in people).  

OA is chronic and progressive inflammation of a joint, leading to the loss of cartilage, thickening of the joint capsule, and bumpy abnormal new bone formation (osteophytes), causing chronic pain and eventual limb dysfunction or disuse. 

Normal knee vs osteoarthritis knee

Causes of Arthritis in Dogs and Cats

  • Congenital deformities such as hip dysplasia, elbow dysplasia, luxating patellas

  • Body conformation due to people breeding animals without regard to their health, such as any dog with short crooked legs (chondrodysplasia) as with basset hounds, bulldogs, dachshunds, munchkin cats, or with sloped hips like German shepherds.

  • Being over weight

  • Trauma such as broken bones, torn ligaments, infection of a joint

  • Inappropriate nutrition

  • Routine over-exercise or routine intense exercise

NOTE: OLD AGE IS NOT A CAUSE OF ARTHRITIS

Most pets who have osteoarthritis were born with the joint problems that lead to osteoarthritis due to their breed standard or due to poor breeding, even though they are not usually diagnosed until they are older.  

 

Symptoms of Arthritis in Dogs

Pre-clinical Stage:

The dog has a congenital condition such as luxating patellas, hip dysplasia, elbow dysplaisa, or chondrodysplasia that lead to OA.  Other common risk factors are being over weight, routinely performing intense exercise, joint trauma.  However there are no symptoms yet.  

​Mild Clinical Signs:​​

  • Mild soreness or stiffness after heavy exercise

  • Subtle changes in joint loading

  • Subtle changes in stance at standstill

Moderate Clinical Signs:

  • Obvious changes in limb loading

  • Obvious changes in stance at standstill, body weight distribution changes

  • Limping even without exercise

  • Difficulty in getting up

  • Decreased range of motion of affected joint

  • Crepitus of the joint (I can feel the osteophytes when flexing or extending the joint)

  • Possible aggression due to pain

  • Decreased activity- may not play as long as before

Severe Clinical signs:

  • Reluctance, extreme difficulty, or downright refusal to go up or down stairs, jump onto furniture or into a vehicle

  • Muscle loss

  • Limited activity- the dog won't do anything unless encouraged

  • Aggression due to pain

  • Severe weight shifting

  • Severe limping

  • Extreme difficulty in getting up from a sitting or laying position

Healthy dog with normal standing posture.  Weight is properly distributed, head held high, muscles in good condition.

This dog has signs of OA due to hip dysplasia.  Because this dog has pain in his hips, he's been loading his weight abnormally to the strong front legs.  Look how skinny his back legs are- there's hardly any muscle left!  He's placing his front legs under his body instead of below his shoulders like the dog above.  And look how low his head is hanging- poor dog!

Healthy cat standing normally to eat. Good muscle condition, standing tall with tail held high.   

Notice the severe muscle loss and completely abnormal posture of this arthritic kitty trying to eat.  His coat is scruffy due to lack of grooming. Tail is low instead of happy and high like the cat above.  Poor old kitty!

Symptoms of Osteoarthritis in Cats

Pre-clinical: the most common risk factor for the development in OA in cats is being over weight.  However there are no clinical signs yet.  

Mild Clinical Signs:

  • Not jumping or climbing as high as previously

  • Not jumping or climbing as often as previously

  • Decreased activity level

  • Reluctance to play

Moderate Clinical Signs:

  • Limping or stiffness

  • Changes in stance at standstill, body weight distribution changes

  • Difficulty in getting up, or stiffness in getting up from a laying down position

  • Increased sleeping or resting

  • Decreased range of motion of affected joint

  • Crepitus in the joint

  • Possible aggression due to pain

  • Possible reluctance to use litter box

Severe Clinical Signs

  • Reluctance, extreme difficulty, or downright inability to go up or down stairs, jump onto higher vertical surfaces

  • Muscle loss

  • Severely limited activity

  • Decreased interaction or avoidance of family members or playmates

  • Limping

  • Severe weight shifting

  • Extreme difficulty in getting up from a laying down position

  • Possible aggression due to pain

  • Inability to use litter box unless modified

  • Decreased grooming activities

Prevention of Osteoarthritis

  • Avoid dog and cat breeds with extreme body conformation, such as chondrodysplasia, those with long backs, breeds prone to congenital problems such as hip dysplasia, elbow dysplasia, etc.

  • Demand proof of freedom from congenital defects from the breeder: PennHip certification, OFA certification.  Do not trust any breeder who can not produce proof!  They often say they don't have problems but if they're not screening all of their litters, they don't really know- or care!

  • ASK YOUR VET to help you evaluate a breeder or particular dog or cat before agreeing to purchase or adopt it.

  • Provide proper nutrition at all life stages.

  • Never let your dog or cat get over weight.  

  • Provide routine moderate exercise.

  • Provide a safe environment; do not allow your pet to roam freely where they can be hit by cars, kicked by horses, shot, etc.  

Just say NO to breeds with deformed joints!

Don't let your pet get fat!

Keep your pet safely confined!

Treatments for Osteoarthritis Proven to Work- The MUST HAVES

  • Weight management and proper nutrition are key factors in treating OA.  Multiple studies have proven that pets with OA on the thinner side of normal have better mobility and less pain than pets with OA who are over weight.  For pets who are only mildly overweight, the treatment is simple and actually saves money- feed your pet less food!  For pets who are moderately to severely overweight, a prescription diet may be necessary to ensure proper nutrition despite strict calorie reduction.

  • Non-steroidal anti-inflammatory drugs (NSAIDs) treat pain and inflammation which is why they are often the first line of treatment besides weight management in the treatment of OA.  By reducing inflammation, we are also slowing the progression of joint destruction, maintaining a higher quality of life for a longer time.  Many people want to avoid chronic NSAIDs or wait to try other things first but this is absolutely the wrong approach.  In fact, studies have shown that the earlier NSAIDs are started, the better the results in treatment long-term.  Lab work is required before starting chronic NSAIDs to evaluate your pet's liver and kidney function, since most NSAIDs are metabolized by these organs.  We repeat the lab work in 2-4 weeks to ensure there are no rare but serious adverse effects.  To help budget the costs of 2 sets of lab work and 2 exams and multiple rechecks, we've created the Chronic Disease Add-On to the Preventive Care PLUS Packages.  

  • Omega-3 fatty acids are a natural anti-inflammatory that work in conjunction with NSAIDs to reduce the molecules and inhibit that pathways of chronic inflammation that cause joint destruction.  This is one of our must haves in treating OA in dogs and cats.  

  • For pets with defective joints such as those with hip or elbow dysplasia, surgical correction is ideal.  Surgery is most effective before signs of OA are evident, before the joints are permanently damaged.  Obviously surgery is quite expensive and it is not possible to surgically correct some joints.  

Treatments for Osteoarthritis That Most Likely Help

  • Supplements containing glucosamine, chondroitin sulfate, green-lipped mussel, and avocado soybean unsaponifiables (ASUs) have some decent evidence of efficacy (proven to work) with very few side effects.  

  • Disease Modifying Osteoarthritic Drugs (DMOADs) such as Adequan, Pentosan, or Cartrophen work several different ways.  They help reduce the products of inflammation that destroy cartilage and promote the formation of cartilage. There are a few studies that show some improvement in the symptoms of OA when used in conjunction with NSAIDs and weight management.  

  • Physical rehabilitation is the diagnosis and management of patients with painful or functionally limiting conditions, particularly those with injury or illness related to the neurologic and musculoskeletal systems. The goal of rehabilitation is to achieve the highest level of function, independence, and quality of life possible for the patient.  It is particularly important in pets with muscle loss and decreased function.  

  • Modification of exercise is important in reducing pain while encouraging use of the affected joints.  Typically high impact exercise is restricted and replaced with low impact exercises that help restore muscle mass or range of motion.  It's important to rely on the advice of a veterinarian to help you design an exercise program for your pet with OA because the wrong exercise, frequency, or duration can cause more harm than good.

  • Other medications may be necessary for some pets who are painful despite NSAIDs, omega-3 fatty acids, weight loss, and supplements.  We commonly prescribe gabapentin to pets who have back and neck pain due to chronic abnormal weight bearing, like the labrador with hip dysplasia in the picture.  In dogs we may add tylenol (acetaminophen) which isn't anti-inflammatory but may help in patients with severe pain.  In very severe cases, we can administer a "pain reset" cocktail of IV medications in the hospital to dramatically reduce the level of chronic pain very quickly, then adjust the oral medications for maintenance.  It's much better to treat pain aggressively at first (to "get ahead"), then taper medications if possible, than to stay behind and try to add more medications to catch up to pain.  That's why we administer pain medications to patients before they have surgery- it works better.  

  • Acupuncture is a treatment that we don't fully understand but it does seem to help some patients with OA.  Acupuncture has been studied quite extensively and the results of the studies are mixed.  Rarely do pets get worse with acupuncture, however it is NOT a first-line treatment.  We add acupuncture to NSAIDs, weight management, Omega-3 fatty acids, and surgery if it is possible.  That is where acupuncture has the most benefits.

  • Chiropractic may be useful in some cases of OA in animals.  I would caution everyone to use a veterinarian who practices chiropractic and not a human chiropractor who treats animals.  

Treatments with No Proven Efficacy

Unfortunately there are a lot of these, supplements in particular.  The supplement industry is completely unregulated.  There is nothing that forces a supplement manufacturer to show that the product actually works for any given condition.  In fact, the very definition of "supplement" means that they are prohibited from claims that the product treats any disease!  Not only that, but you may not even get the ingredients labeled on the bottle actually in the bottle.  Multiple studies have shown multiple times that supplements may contain anything from toxins, to heavy metals, to basically nothing but glycerin capsules or inert powders.  Products with the USP symbol have at least voluntarily submitted their supplements to this organization and have what is stated in the bottle, so that's a start.  There is no reason to waste your money on trying supplements first, all the while your pet's disease is progressing and making it less likely to achieve full recovery.  

CBD is the apple cider vinegar and coconut oil of present times.  It has been claimed to cure pretty much everything.  It may actually be useful for pain control but because it is not an FDA-labeled medication, it has not been studied extensively for that purpose in dogs or cats.  Like other supplements, multiple studies have found that there is often no actual CBD in a bottle of supposed CBD oil.  The FDA keeps a list of brands tested and found to have deceptive labeling found here.  Again, like other supplements, harmful substances may be found in certain brands that do not test their products.  If you're going to get CBD oil for your pet, I'm technically not allowed to recommend anything.  But this website looks good ;)

Actions You Can Take Now

If you want to help improve your pet's quality of life and treat OA, you can help us by emailing the completed LOAD questionnaire and scheduling your pet's examination.  If OA is diagnosed, we have a very budget-friendly Dog or Cat Chronic Disease Care Plan that includes all of the necessary lab work, follow up exams, and gives you a nice discount on the medications prescribed.  You can even make automatic monthly payments on the plan!  Medications are additional but you get 10% off if ordered through Family Veterinary Mobile Clinic. 

If your pet is overweight, start him or her on a weight loss plan now.  Start by measuring your pet's food, then decrease that amount by 25%.  For example, if your cat eats 1 cup of dry kibble per day, give her 3/4 cup per day instead.  

Of course you can always just call or email us and we'll be glad to help you get your pet feeling better ASAP!